OpenHealth Q&A

Gyn Problem - Insights from US Examination

A 24-year-old female, measuring 5'4" and weighing 128 lbs, has a medical history that includes celiac disease, irritable bowel syndrome (IBS), and successfully treated supraventricular tachycardia (SVT) via cryoablation. She has also experienced large ovarian cysts in the past. Her current medications include birth control, as well as as-needed hyoscamine and ondansetron. Recently, she was jolted awake from sleep due to severe pain located primarily in her mid and right lower quadrant (RLQ). There were no accompanying symptoms of nausea or vomiting, just intense discomfort in her lower abdomen that radiated into her back. Although she has never gone through labor, the pain resembled contractions, with waves of intensity causing her to bend over while swaying in bed. In a bid to alleviate the agony, she took ibuprofen and applied a topical heat rub, which provided some relief, allowing her to return to sleep. The next morning, she awoke to the same torment, prompting her to take additional ibuprofen and simethicone. After realizing that the pain relief wasn’t sufficient, she opted to visit the emergency department (ED), suspecting a potential ruptured ovarian cyst and hoping to receive toradol for pain management. At the ED, doctors conducted a transvaginal ultrasound and a CT scan of her abdomen and pelvis, which yielded no signs of cysts, free fluid, or appendicitis. The only noteworthy finding was a report indicating “mild diffuse thickening of the cervical wall with a small degree of heterogeneity in the upper cervical canal, without increased vascularity.” The impression read, “Mild diffuse thickening of the cervix with a small amount of heterogeneity in the endocervical canal without increased vascularity, which is indeterminate. A follow-up pelvic ultrasound in three months is recommended to monitor for any changes and to correlate with cervical examination results.” She communicated the results to her gynecologist, who expressed no immediate concerns but offered the option for a follow-up in three months. It should be noted that she has had no sexual partners in the past eight to nine months; the only recent internal examination was a Pap smear swab conducted in February, which returned normal results. Her gynecologist assured her that the current findings are unrelated to the Pap test. However, she remains puzzled as to the possible origins of her symptoms, questioning whether the swab might have introduced bacteria leading to an infection. Uncertain if her condition warrants an earlier consultation or a second opinion from another gynecologist, she notes the absence of abnormal bleeding, discharge, or any signs pointing to constipation-related issues, as the CT scan showed no stool burden. She seeks guidance on her next steps given her ongoing discomfort in the lower abdomen, lower back, and vaginal area. Thank you for any insights regarding her situation!

Answers (1)

3/19/2025, 3:01:28 PM

OpenHealth AI

It sounds like you're dealing with a complex situation that's understandably concerning. Your main issues include severe abdominal pain, findings from recent imaging, and uncertainty about the best next steps.

Key Points:

1. Recent Imaging: Your CT and transvaginal ultrasound did not indicate any immediate severe conditions.
2. Persistent Pain: Despite the negative imaging results, your ongoing discomfort requires attention to identify the source and manage symptoms.
3. Cervical Findings: The mild thickening observed in your cervical wall may need monitoring, but it was not deemed an urgent concern by your gynecologist.

Understanding Your Symptoms:

Severe abdominal pain can stem from various causes, including ovarian-related issues, gastrointestinal discomfort, muscular problems, or even referred pain from other areas. The fact that no abnormalities were found in your imaging is a positive sign, but it doesn’t entirely explain your pain.

Next Steps:

1. Pain Management: Continue to manage your pain with over-the-counter medications as you've done, but ensure you’re not exceeding recommended dosages. Incorporating relaxation techniques or gentle heat application can also provide additional relief.

2. Monitor Symptoms: Keep a symptom diary for a week. Note when the pain occurs, its intensity, and what seems to relieve or exacerbate it. This information can be helpful for your doctor in determining the next steps.

3. Consider Timing for Follow-ups:

   • Consult Your Gynecologist Again: If your pain worsens, becomes persistent, or is accompanied by new symptoms such as fever or changes in menstrual flow, reach out to your gynecologist sooner than the suggested three months.
   • Second Opinion: If you feel uncertain about the management plan, consider scheduling a consult with another gynecologist for a fresh perspective, especially focusing on your ongoing pain and any related concerns.

4. Stay Informed: Continue to educate yourself on potential conditions that may explain your symptoms, such as endometriosis, pelvic inflammatory disease (PID), or other gastrointestinal issues. Knowing more can help you discuss your concerns more effectively with your healthcare providers.

Reassurance:

It’s completely normal to feel anxious when experiencing unexplained pain. It’s commendable that you’re seeking answers and treatment for your discomfort. By monitoring your symptoms and seeking follow-up care as necessary, you're taking proactive steps towards finding relief. Remember to prioritize your health and stay in tune with your body. Let me know if you need anything else or further clarification!